Surgical instrument holder

ABSTRACT

An apparatus for holding a surgical instrument relative to a base is provided having a mounting portion configured and dimensioned to engage a portion of a base, a jaw assembly including first and second jaw members which define a retaining area therebetween configured and dimensioned to retain the shaft of a surgical instrument therein and thereby fix the length of the instrument shaft relative to the base and an operative site, and an instrument position adjustment mechanism which includes an adjustment member rotatably disposed in relative to the mounting portion to facilitate selective position adjustment of the jaw assembly with respect to the mounting portion.

CROSS REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Application Ser.No. 60/072,406 filed Jan. 23, 1998, the contents of which are herebyincorporated by reference in their entirety.

BACKGROUND

1. Technical Field

The subject disclosure relates to minimally invasive surgical proceduresand apparatus, and more particularly to apparatus for holding surgicalinstrumentation during surgery associated with the thoracic cavity.

2. Background of Related Art

It is well established that the performance of various types of surgicalprocedures using less invasive techniques and instrumentation hasprovided numerous physical benefits to the patient while reducing theoverall cost of such procedures. One area, for example, which hasexperienced a great increase in the performance of less invasiveprocedures is in the area of heart surgery. In particular, coronaryartery bypass graft (CABG) procedures have been performed using lessinvasive techniques with much success.

Access to the patient's thoracic cavity for such procedures in the pastwas typically achieved by a large longitudinal incision in the chest.This procedure, referred to as a median sternotomy, requires a saw orother cutting instrument to cut the sternum and allow two opposinghalves of the rib cages to be spread apart. U.S. Pat. No. 5,025,779 toBugge discloses a retractor which is designed to grip opposite sternumhalves and spread the thoracic cavity apart. The large opening which iscreated by this technique enables the surgeon to directly visualize thesurgical site and perform procedures on the affected organs. However,such procedures that involve large incisions and substantialdisplacement of the rib cage are often traumatic to the patient withsignificant attendant risks. The recovery period may be extended and isoften painful. Furthermore, patients for whom coronary surgery isindicated may need to forego such surgery due to the risks involved withgaining access to the heart.

U.S. Pat. No. 5,503,617 to Jako discloses a retractor configured to beheld by the surgeon for use in vascular or cardiac surgery to retractand hold ribs apart to allow access to the heart or a lung through anoperating window. The retractor includes a rigid frame and a translationframe slidably connected to the rigid frame. Lower and upper blades arerotatably mounted to the rigid frame and the translation framerespectively. Such a “window” approach requires instrumentation that canbe inserted into and manipulated within the limited space available inand around the surgical site.

Therefore, a continuing need exists for more versatile and variedsurgical instrumentation which facilitates performing surgicalprocedures in limited access cavities of a patient during less invasivesurgical procedures. A need also exists for instrument holding apparatusto retain surgical instruments in place during surgical procedures andfree the surgeons hands.

SUMMARY

The present disclosure addresses the above-noted needs while providingvarious embodiments of an apparatus for holding surgical instrumentsthat have many unique features and advantages over the priorinstrumentation. The presently disclosed apparatus for holding surgicalinstruments provides greater versatility during surgical procedureswhich are less invasive than traditional procedures.

For example, in one embodiment, the present disclosure provides anapparatus for holding a surgical instrument relative to a base, whichincludes a mounting portion configured and dimensioned to engage aportion of a base, a jaw assembly including first and second jaw memberswhich define a retaining area therebetween configured and dimensioned toretain the shaft of a surgical instrument therein and thereby fix thelength of the instrument shaft relative to the base and an operativesite, and an instrument position adjustment mechanism which includes anadjustment member rotatably disposed in relative to the mounting portionto facilitate selective position adjustment of the jaw assembly withrespect to the mounting portion.

The instrument position adjustment mechanism may include a lock membersuch that when positioned in a locked position, the adjustment member isprevented from moving relative to the mounting portion and when the lockmember is positioned in an unlocked position, the adjustment member ispermitted to move relative to the mounting portion. The jaw assemblypreferably includes a jaw approximation control member which controlsmovement of one of the first and second jaw members relative to theother of the first and second jaw members.

BRIEF DESCRIPTION OF THE DRAWINGS

Various preferred embodiments are described herein with reference to thedrawings, wherein:

FIG. 1 is a perspective view of a surgical retraction systemincorporating a variety of retractors, a heart manipulator and a heartstabilizer, all positioned on a base;

FIG. 2 is a perspective view of the instrument holder of the presentdisclosure showing an instrument shaft retained in the horizontalposition and the jaws in the open position;

FIG. 3 is a side view of the instrument holder in the position of FIG.2;

FIG. 4 is a perspective view of a first section of a base mountingassembly of the present disclosure;

FIG. 5 is a perspective view of a second section of the base mountingassembly;

FIG. 6 illustrates the ball for enabling maneuverability of the jawassembly;

FIG. 7 illustrates a side view of the shaft which is connected at oneend to the ball and at the opposite end to the jaw assembly;

FIG. 8 is a side view of the locking screw which retains the ball in afixed position;

FIG. 9 illustrates the handle which attaches to the locking screw forrotating the screw;

FIG. 10 is a side view showing the handle attached to the locking screwto form a ball locking assembly;

FIG. 11 is a perspective view illustrating the instrument holder withthe jaws in the closed position and maneuvered to hold the instrumentshaft at an angle;

FIG. 12 is a side view illustrating the instrument holder maneuvered toposition the instrument shaft perpendicular to the base of theretraction system;

FIGS. 13A and 13B are perspective and side views, respectively, of thestationary jaw for holding the instrument shaft;

FIG. 14 is a perspective view of the movable jaw;

FIG. 15 is a perspective view of an alternative embodiment of aninstrument holder constructed in accordance with the present disclosure;and

FIG. 16 is a side view of the instrument holder embodiment of FIG. 15.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The instrument mounting holder of the present disclosure is designed tomount various accessory instruments to the ring base disclosed in U.S.patent application Ser. No. 08/718,283, filed Sep. 20, 1996, the entirecontents of which are incorporated herein by reference. FIG. 1 is adrawing from the '283 patent application and shows a base 50, retractors60, 70 and 80, a heart stabilizer 90 and a heart manipulator 100. Adetailed description of these instruments, how they are mounted to thebase 50, and their surgical function is disclosed in the '283application.

The present disclosure is directed to an instrument holding apparatus,which is removably positionable on base 50, and can mount a variety ofinstruments such as an illumination instrument, a grasper, a retractor,a heart stabilizer or any other instrument that would be useful inperforming the surgical procedure. Only the shaft of the accessoryinstrument is shown in the drawings and is represented generically byreference letter “S”.

Referring to FIGS. 1-5, instrument holder 1 includes a mounting portion,such as a base mounting assembly 10 composed of a first section 12 and asecond section 14, an instrument position adjustment mechanism 30, and ajaw assembly 51 for supporting the instrument shaft S. As best shown inFIG. 4, first section 12 includes a neck 19 having a socket 15 formedtherein for receiving a ball 32, described below. A lip 18 is formed tohook around a front edge 45, FIG. 1, of base 50. An extension 16 extendsthrough a groove 22 formed in second section 14, shown in FIG. 5. A lip20 of second section 14 is configured to mount to an outer edge 46 ofbase 50. A biasing spring, not shown, is attached at one end to firstsection 12 and at the opposite end to second section 14 to help retainthe sections 12 and 14 together while allowing first section 12 andsecond section 14 to be pulled slightly away from each other, againstthe force of the spring, to facilitate mounting to and release from base50.

Referring to FIGS. 6-12, position adjustment mechanism 30 includes aball 32, FIG. 6, a ball shaft 34, FIG. 7, a lock member such as lockingscrew 36, FIGS. 8 and 10, and a locking screw handle 38, FIGS. 9 and 10.Ball 32 is attached to end 35 of ball shaft 34. Alternatively, ball 32and shaft 34 could be integral. End 37 of ball shaft 34 is attached tojaw assembly 51. Ball 32 is maneuverable by rotational and pivotalmovement through a multitude of positions within neck 19 in order tomaneuver the jaws to position the shaft S (and associated instrument) ina variety of orientations. Such maneuverability is shown for example bycomparing FIGS. 3, 11 and 12. Once the jaw assembly 51 is maneuvered tothe desired position, handle 38, which is attached to locking screw 36via arm 39 extending through aperture 41, is rotated to advance lockingscrew 36 so that abutment end 33 tightly presses against ball 32. Thislocks ball 32 in position and prevents movement thereof.

Referring to FIGS. 13A, 13B and 14, jaw assembly 51 includes a movablejaw 64 having an internally threaded opening 71 to receive mountingscrew 58 of a stationary jaw 52. Arm 66 of movable jaw 64 is mountedwithin a groove 56 formed on stationary jaw 52. Ball shaft 34 isadhesively mounted within a recess (not shown) of stationary jaw 52,although other means of connection are also contemplated. A jawapproximation control member, such as locking knob 72, as best shown inFIGS. 3 and 10, is attached to a mounting screw 58 such that rotation oflocking knob 72 rotates threaded mounting screw 58 to advance movablejaw 64 towards a stationary jaw 52. Spring 59 biases movable jaw 64 tothe open position, away from stationary jaw 52. Approximation of jaws 52and 64 grasps and retains instrument shaft S therebetween. Referringback to FIG. 2, in conduction with FIGS. 13A, 13B and 14, a pair offriction enhancing members such as rubber pads 54 and 69 are mountedwithin grooves 61 and 68 formed on stationary jaw 52 and movable jaw 64,respectively, to facilitate a traumatic grasping of instrument shaft S.

In use, instrument shaft S is placed between movable jaw 64 andstationary jaw 52 with the jaws in the open position as shown in FIG. 2.Knob 72 is rotated to close the jaws 64, 52 to clamp and securely holdthe instrument shaft S. Jaw assembly 51 is manually moved to positionthe instrument shaft S at the desired angle relative to base 50 as ball32 pivots within socket 15 of neck 19. Once pivoted to a desiredposition, for example, the position shown in FIG. 11 or FIG. 12 (otherpositions are clearly contemplated), locking screw handle 38 is rotatedto advance locking screw 36 against ball 32 to lock ball 32 in place.This prevents further movement of the jaw assembly 51.

Referring to FIGS. 15 and 16, an alternative embodiment of the presentlydisclosed apparatus for holding instruments is designated as instrumentholder 100. Instrument holder 100 is similar to instrument holder 1.Therefore, the following description will only focus on those aspects ofinstrument holder 100 which differ from instrument holder 1. In contrastto base mounting assembly 10 of instrument holder 1, instrument holder100 includes a mounting portion, such as a base mounting assembly 110which is in the form of a clip having first and second lips 118, 120which extend from a bottom surface of mounting assembly 110. Mountingassembly 110 is preferably fabricated from flexible material andincludes a cantilevered extended portion 111 which deflects upon theapplication of a generally vertically directed force. Thus, in order tomount instrument holder 110 to base 50, lip 118 is fitted over the innerrim of base 50 and instrument holder 100 is moved into closerapproximation with base 50 so that lip 120 cams outwardly and flexesextended portion 111 upwardly until lip 120 passes over the outer edgeof base 50 and snaps back to its normal configuration as shown in FIG.16. Once positioned on base 50, instrument holder 100 functions in thesame way as instrument holder 1 described above to retain surgicalinstruments therein.

Another difference between instrument holder 100 and instrument holder 1is the configuration of the locking knob. In particular, screw handle 38of instrument holder 1 is in the form of a rotatable lever whereas screwhandle 138 of instrument holder is in the form of a wing having extendedportions 138 a and 138 b extending radially outwardly from the centeralong a plane.

It will be understood that various modifications may be made to theembodiments of the apparatus for holding surgical instruments shown anddescribed herein. Therefore, the above description should not beconstrued as limiting, but merely as examples of preferred embodiments.Those skilled in the art will envision other modifications within thescope and spirit of the present disclosure.

What is claimed is:
 1. An apparatus for holding a surgical instrumentrelative to a base, which comprises: a mounting portion having first andsecond sections which cooperate to engage a portion of a base; a jawassembly having first and second jaw members which define a retainingarea therebetween which is configured and dimensioned to receive a shaftof the surgical instrument, the jaw assembly movably disposed relativeto the mounting portion to facilitate selective positioning of thesurgical instrument within a surgical site and a spring-type retainingmember for locking the mounting portion to the base.
 2. An apparatus forholding a surgical instrument relative to a base according to claim 1wherein at least one of the sections of the mounting portion is movablydisposed relative to the other of the sections.
 3. An apparatus forholding a surgical instrument relative to a base according to claim 1wherein at least one of the sections of the mounting portion includes aflange for engaging a rim portion of the base.
 4. An apparatus forholding a surgical instrument relative to a base according to claim 1wherein the jaw assembly includes a jaw approximation control memberwhich controls movement of at least one of the jaw members relative tothe other jaw member to selectively fix the length of the surgicalinstrument relative to the base.
 5. An apparatus for holding a surgicalinstrument relative to a base according to claim 1 wherein the jawapproximation control member is rotatable.
 6. An apparatus for holding asurgical instrument relative to a base according to claim 1 furthercomprising an instrument position adjustment mechanism which includes anadjustment member for moving the jaw assembly relative to the mountingportion.
 7. An apparatus for holding a surgical instrument relative to abase according to claim 6 wherein the adjustment mechanism furtherincludes a lock member for selectively locking the jaw assembly relativeto the mounting portion.
 8. An apparatus for holding a surgicalinstrument relative to a base according to claim 7 wherein the lockmember is rotatable.
 9. An apparatus for holding a surgical instrumentrelative to a base according to claim 6 wherein the adjustment mechanismincludes a ball which facilitates rotational and pivotable movement ofthe jaw member about the mounting portion.
 10. A method of mounting aninstrument holder to a base, comprising the steps of: a) providing anapparatus for holding a surgical instrument which includes a mountingportion having first and second sections which cooperate to engage aportion of a base, a jaw assembly having first and second jaw memberswhich define a retaining area therebetween which is configured anddimensioned to receive a shaft of the surgical instrument, the jawassembly movably disposed relative to the mounting portion to facilitateselective positioning of the surgical instrument within a surgical siteand a spring-type retaining member for locking the mounting portion tothe base; b) moving one of the sections relative to the other of thesections to selectively engage the portion of the base; c) moving thesurgical instrument to a desired position between the jaw members; d)selectively locking the jaw members about the shaft of the surgicalinstrument; e) moving the jaw assembly relative to the mounting portion;and f) selectively locking the jaw assembly relative to the mountingportion to position the surgical instrument at a desired location withinan operative site.
 11. A method of mounting an instrument holder to abase according to claim 10 wherein after the moving step of step (a),the method further comprises the step of: providing an adjustmentmechanism which includes an adjustment member for moving the jawassembly relative to the mounting portion.
 12. A method of mounting aninstrument holder to a base according to claim 10 wherein after themoving step of step (a), the method further comprises the step of:selectively locking the mounting portion relative to the base.